NHIA pushes back on ASP

Monday, July 27, 2015

WASHINGTON – The House of Representatives on June 17 passed a bill that included a provision that would switch payment for Part B home infusion drugs to an average sales price model—a model that is unsustainable, say infusion stakeholders.

“The services that are associated with Part B infusion drugs are not reflected in the policy lawmakers are moving forward,” said Kendall van Pool, vice president of legislative affairs for the National Home Infusion Association. “If this becomes law, home infusion providers would be drastically under-reimbursed.”

Home infusion drugs are currently paid using an average wholesale price model. An April report from the Office of Inspector General stated that CMS could have saved $251 million over 18 months if it used an ASP model instead. However, even the OIG noted that it hadn’t factored in the services, says NHIA.

“If you (interrupt access), patients will be moved into skilled nursing facilities, which is more expensive,” said van Pool. “By changing the drug rates and saying, ‘Oh, we’re on pace to save all this money,’ it’s not a full picture of what’s going on.”

Besides overlooking the cost of services, the ASP model also doesn’t allow for a differentiation of types of consumers, say stakeholders.

“Hospitals pay far less than a home infusion provider,” said David Franklin, president of Advanced Care Consulting Services. “ASP generally is far less than acquisition costs for a home infusion provider. They simply can’t do it.” 

NHIA is no stranger to educating lawmakers on the value of home infusion. It has been working since 2006 to create a meaningful benefit for the therapy, most recently with “The Medicare Home Infusion Site of Care Act of 2015,” introduced in both the House and Senate in February.

“We’re working with the Senate where there is a better understanding of these issues,” said van Pool. “This is not a new issue for us and the Care Act can fix the problems the OIG pointed out, but do it the right way.”